LV Volume / Pressure Overload

Dilated CMP, Ischemic (Case 3)

FINDINGS
IMPRESSION
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Impression:

  • Markedly increased LV volume (3+).
  • Moderate increase in RV uptake (2+).
  • Mixed transmural / nontransmural MI in the inferior lateral wall (arrows) (5/25 segments) (RCA territory).
  • Moderate-to-severe ischemia in the apical 2/3 of the lateral and anterolateral walls (6/25 segments) (small lines).

    Coronary angiography:

  • LAD - 30% proximal and 40% mid portion stenosis; 1st diagonal branch - totally occluded with left-to-left collaterals.
  • LCX - 80% proximal stenosis.
  • RCA - totally occluded.

    ECHO:

  • Marked LV dilatation with moderate reduction of systolic function. EF=35%.
  • Extensive inferior-posterior-lateral wall motion abnormality.
  • Mild TR and AR (1+) and moderate MR (2+).

    Cardiac catheterization:

  • RV - 38/8
  • PCW - 13/14/11
  • PAP - 38/14

    Comments:
    The LV volume is markedly increased while the rest perfusion abnormalities are moderate extensive and severe. The LV volume appears somewhat larger than the rest perfusion abnormalities can explain. An additional factor may be in effect.

    An MR (2+) was found on Doppler. The concomitant MR probably provides additional volume overload leading to the observed degree of LV dilatation. The systolic LV function is only mild-to-moderately impaired (ECHO LVEF=35%), further increasing the likehood of the above scenario.
    The increaced RV uptake indicate RV pressure overload and pulmonary hypertension (backward failure) confirmed by Cardiac Cathetherizaton . The MR plays a very significant role in this patient's total picture.

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    Atlas of Myocardial Perfusion SPECT
    © Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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    Initiated: Nov 19, 1995. Last updated: April 26, 1999.